Student Information Form

Student's First Name REQUIRED Please fill out this field. Please enter valid data.

Student's Last Name REQUIRED Please fill out this field. Please enter valid data.

Grade for 2022 REQUIRED Please fill out this field.

Birthdate REQUIRED Please fill out this field. Please enter a date.

Please check the statement that best describes your St. Matthew enrollment status. REQUIRED Please fill out this field.

School or daycare your child attended in 2021 Please enter valid data.

Address Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Is your child Hispanic? REQUIRED Please fill out this field.

Is your child fluent in English? REQUIRED Yes No Please fill out this field.

If no, please list languages spoken Please enter valid data.

Child's Ethnicity REQUIRED American Indian/Native American Asian Black Multi-Racial Native Hawaiian/Pacific Islander White Please fill out this field.

Please list who child lives with, their relationship, and their ages REQUIRED Please fill out this field. Please enter valid data.

Home Status Lives with both biological parents Lives with one parent Lives with mother and stepfather Lives with father and stepfather Parents are separated/divorced Lives with legal guardian

Is there a court order in place for legal custody? REQUIRED Yes No Please fill out this field.

If yes, please email or mail to Saint Matthew School.
StMattsAdvancement@gmail.com
or
Saint Mattew School
attn: Mrs. Malloy
3040 Cottman Ave.
Phila., Pa. 19149

Is there a court order in place for physical custody? REQUIRED Yes No Please fill out this field.

If yes, please email or mail to Saint Matthew School.
StMattsAdvancement@gmail.com
or
Saint Mattew School
attn: Mrs. Malloy
3040 Cottman Ave.
Phila., Pa. 19149

Does your child receive special services? REQUIRED Yes No Please fill out this field.

If yes, please explain: Please enter valid data.

Does your child have an IEP (Individualized Education Plan) or a PsychoEducational Evaluation Plan? REQUIRED Please fill out this field.

If yes, please email or mail to Saint Matthew School.
StMattsAdvancement@gmail.com
or
Saint Mattew School
attn: Mrs. Malloy
3040 Cottman Ave.
Phila., Pa. 19149

Father's Name REQUIRED Please fill out this field. Please enter valid data.

Father's Ethnicity REQUIRED American Indian/Native American Asian Black Multi-Racial Native Hawaiian/Pacific Islander White Please fill out this field.

Father's Country of Birth REQUIRED Please fill out this field. Please enter valid data.

Father's City and State of Birth REQUIRED Please fill out this field. Please enter valid data.

Father's Languages Spoken REQUIRED Please fill out this field. Please enter valid data.

Father's Religion REQUIRED Please fill out this field. Please enter valid data.

Father's Occupation REQUIRED Please fill out this field. Please enter valid data.

Mother's Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Ethnicity REQUIRED American Indian/Native American Asian Black Multi-Racial Native Hawaiian/Pacific Islander White Please fill out this field.

Mother's Country of Birth REQUIRED Please fill out this field. Please enter valid data.

Mother's City and State of Birth REQUIRED Please fill out this field. Please enter valid data.

Mother's Languages Spoken REQUIRED Please fill out this field. Please enter valid data.

Mother's Religion REQUIRED Please fill out this field. Please enter valid data.

Mother's Occupation REQUIRED Please fill out this field. Please enter valid data.

Do you have a child already at St. Matthew School? REQUIRED Please fill out this field. Please enter valid data.

I agree the information on this form is true at time of submission.

I Agree Please select this field.

St. Matthew School

3040 Cottman Avenue Philadelphia, PA 19149

Student Information Form

Print and Mail Version

Online Version